A formulation based on Ehlers and Clark's cognitive model of PTSD — mapping the nature of the trauma memory, negative appraisals, sense of current threat, and the maintaining strategies.
This formulation explains why trauma symptoms persist: the trauma memory is stored differently from normal memories (fragmented, vivid, lacking time context), leading to intrusions and a sense of current threat. Negative appraisals of the trauma and its aftermath maintain distress, while coping strategies (avoidance, rumination, suppression) prevent the memory from being properly processed. Work through it with your therapist — you do not need to describe the trauma in detail.
Use early in treatment once a PTSD diagnosis is confirmed, to build a shared understanding of why symptoms are persisting. Central to Ehlers and Clark's cognitive therapy for PTSD, which has the strongest evidence base for single-incident trauma.
Explain that PTSD symptoms persist not because of the trauma itself but because of how the memory was processed and what the experience came to mean. Frame the formulation as a roadmap that will guide every subsequent intervention.
For clients with multiple traumas, formulate the index trauma first and note how earlier experiences may have shaped the appraisals. For clients with comorbid dissociation, ensure adequate grounding skills are in place before detailed formulation work.
Delay if the client is currently in an unsafe living situation, actively suicidal, or using substances at a level that would impair trauma processing. The formulation involves engaging with trauma content, so ensure stabilisation needs are met first.
The two key maintaining mechanisms are the nature of the trauma memory (fragmented, poorly contextualised, with strong sensory re-experiencing) and the negative appraisals of the trauma and its aftermath. Ensure both are clearly mapped, as they drive different interventions.
Suitable for clients working with ptsd, trauma, formulation, ehlers, clark, cognitive model, cbt, flashbacks, appraisals. This tool can be used as a standalone worksheet or as part of a structured homework plan.
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Practise and record the use of grounding techniques when experiencing flashbacks, dissociation, or overwhelming emotions.
Explore how the traumatic event has affected your beliefs about yourself, others, and the world.
Write a structured impact statement exploring how the trauma has affected your beliefs about safety, trust, power, esteem, and intimacy.
Prepare for a visit to the trauma site, record predictions, and process the experience afterwards to update the trauma memory.